目的了解迁延性腹泻病结肠黏膜患儿的内镜下特点及血清和结肠灌洗液中一氧化氮(NO)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平变化及意义。方法选择2009年3月-2010年6月本科收治的迁延性腹泻病患儿115例(迁延性腹泻组)。另选择同期住院的急性腹泻病患儿115例(急性腹泻组)及体检健康儿童115例(健康对照组)作为对照。对迁延性腹泻组患儿行结肠镜检查。3组患儿均采用硝酸还原酶法测定血清NO水平,硫代巴比妥法测定MDA水平,黄嘌呤氧化酶法测定SOD水平。结果迁延性腹泻组患儿结肠镜下所见病变主要以左半结肠为主,其中43例结肠黏膜呈大小为1～2 mm疱疹样改变伴充血糜烂;52例患儿结肠黏膜糜烂水肿;12例结肠黏膜充血水肿,血管网模糊;8例未见明显异常。迁延性腹泻组结肠灌洗液中NO、MDA、SOD水平治疗前后比较差异均有统计学意义(u=10.32、6.57、4.00,Pa<0.05)。迁延性腹泻组和急性腹泻组血清NO、MDA水平比较差异均无统计学意义(u=0.85、0.78,Pa>0.05),SOD水平比较差异有统计学意义(u=57.13,P<0.01)。健康对照组血清NO、MDA、SOD水平与迁延性腹泻组(u=12.07、10.53、17.70,Pa<0.01)及急性腹泻组(u=14.70、9.79、7.33,Pa<0.05)比较差异均有统计学意义。迁延性腹泻组治疗前后血清NO、MDA、SOD水平比较差异均有统计学意义(u=7.99、6.80、12.84,Pa<0.05);急性腹泻组治疗前后血清NO、MDA、SOD水平比较差异均有统计学意义(u=11.31、6.95、8.59,Pa<0.05)。结论 NO生成所产生氧自由基及脂质过氧化反应在腹泻病的发病中发挥重要作用,并能导致结肠黏膜损害,而保护性因素(SOD)的持续降低则是腹泻病迁延不愈的重要因素。 Objective To investigate the endoscopic features and the changes of serum nitric oxide (NO), malondialdehyde (MDA) and superoxide dismutase (SOD) in colonic mucosa of patients with persistent diarrhea. Methods A total of 115 patients with persistent diarrhea admitted to our hospital from March 2009 to June 2010 were selected. Another 115 cases of acute diarrhea hospitalized in the same period (acute diarrhea group) and 115 healthy children (healthy control group) were selected as controls. Colonoscopy in children with persistent diarrhea. Nitric acid reductase was used to measure serum NO level in all three groups. MDA level was measured by thiobarbituria method and SOD level was measured by xanthine oxidase method. Results The patients with persistent diarrhea underwent colonoscopy mainly in the left colon, of which 43 cases of colonic mucosa were 1 ~ 2 mm in size with congestive erosion; 52 cases of colonic mucosal edema; 12 Cases of colon mucosal congestion and edema, vascular network fuzzy; 8 cases no obvious abnormalities. The levels of NO, MDA and SOD in colonic lavage fluid in patients with persistent diarrhea were significantly different before and after treatment (u = 10.32,6.57,4.00, Pa <0.05). There was no significant difference in serum NO and MDA levels between persistent diarrhea group and acute diarrhea group (u = 0.85,0.78, Pa> 0.05). The difference of SOD level was statistically significant (u = 57.13, P <0.01). The levels of NO, MDA and SOD in healthy control group were statistically different from those in persistent diarrhea group (u = 12.07, 10.53, 17.70, Pa <0.01) and acute diarrhea group (u = 14.70,9.79,7.33, Pa <0.05) Significance of learning. The levels of NO, MDA and SOD in patients with persistent diarrhea before and after treatment were significantly different (u = 7.99,6.80,12.84, Pa <0.05). There were significant differences in serum NO, MDA and SOD before and after treatment in acute diarrhea group Statistical significance (u = 11.31, 6.95, 8.59, Pa <0.05). Conclusions Oxygen free radicals produced by NO production and lipid peroxidation play an important role in the pathogenesis of diarrheal diseases and can lead to damage of colonic mucosa. The continuous decrease of protective factor (SOD) is important for the delayed healing of diarrhea factor.